眼科學(xué)課件：角膜疾病

Cornealdisease

TheeyeisthewindowofthehumanbodythroughwhichitfeelsitswayandenjoysthebeautyoftheworldAnatomyofcorneaAnatomicalcharacteristicsLocatedinthefrontoftheeye,corneacontactdirectlywiththeoutsideworld,soitisvulnerable

Novesselincornealeadtoweakself-recoveryabilitywhencorneallesionsoccur.AbundantofsensorynerveRelativeimmuneprivilege

transparentProtectivemembraneWindowCornealfunction

CompleteepitheliumandtearfilmUniformstructureAvascularityDehydrationstateBarrierfunctionofepitheliumandendothelium;Endothelium”pump”oncepathologicalchange，transparentcornealwillchangetoopacity BBEtiologicalfactors:

Biologicalfactor:germ、virus、fungus、protozoonPhysicalfactor：mechanical、heat、radiationChemicalfactor：acid、alkali、metalGeneticfactor：congenitalabnormality、degenerationNutritionalfactor：Vitamine、lipid

Immunereaction：

Tumor:KeratitisConcept:protectiveabilitydecreasingandallkindsofpathogenicfactors(includingofexogenousandendogenous)attackingleadtocornealinflammation

degeneration、exudation、hyperplasiaClassification(etiology)

infectiveallkindsofpathogensexogenoussystemicdisease

localspreadinginflammationfromadjacenttissues病理4stagesInfiltrationstagesymptom:hyperemia,edema,exudation,grayopacification;signs:pain,photophobia,tearing,decreasedvisionUlcerformationstage

cornealulcer,edema,descementocele,perforation,fistulaleadingtoUveitis,especiallyinfunguskeratitisUlcerregressionstage角膜炎的病理過程UlcerformationdescementoceleUlcerandendophthalmitis,hypopyonperforation，irislockingHealingstagecornealnebula(角膜云翳)

cornealmacula(角膜斑翳)

adherentleucoma(角膜粘連性白斑

)cornealstaphyloma(角膜葡萄腫

)MicrobesCornealnebulaCornealmaculaCornealleucomadescemetoceleCornealfistulaAdherentleucomaCornealstaphylomaCornealulcerCornealinfiltrationClinicalfeaturesSymptomspaintrigeminalnerveendingsphotophobia,tearing,blepharospasmsecretionvisionchange

Signs:

hyperemia,infiltration,ulcerhypopyonDiagnosis

stimulatingsymptoms:

pain,photophobia,tearing,blepharospasm

BasicsignsLaboratoryexaminationTreatmentRemovingcausesControllinginfectionPromotinghealingReducingscarBacterialkeratitis病原RiskfactorsLocalDryeyelacrimalductobtructionBullouskeratopathyBlepharitiscontactlensTrichiasiscornealtraumaCornealdiseasesystemicdiabetescomasevereburnimmunosuppressivedrugsalcoholgpoisoningnutritiondisordersrheumatismClinicalmanifestation

acutesymptoms

stimulatingsymptom:painphotophobiatearing

visiondisordersSigns

purulentsecretioneyelidandconjunctivaledmaciliary/mixedcongestioncornealinfiltrationulcerformationStreptococcuspneumoniaekeratitisPseudomonaskeratitisypliquefactivenecrosisStromathinningzMasshypopyonLocalabscesslesionRoundorellipsehypopyonTreatmentDrugs:Antibiotics

FrequentlylocaldrugsandsystemicadministrationEyedrops,eyeointment

AccordingtoresultsoflaboratoryexaminationOtherdrugs

CycloplegicsCollagenaseinhibitors

corticosteroidsOperation:cornealdebridementkeratoplastypseudomonasaeruginosacornealulcer（preoperative）pseudomonasaeruginosacornealulcer（postoperative）FungalkeratitisCommonpathogenicfungus

fusarium鐮刀菌屬Filamentousfungiaspergillus曲霉菌屬

絲狀菌

penicillium青霉菌屬

yeastcandida念珠菌屬

EtiologyRiskfactorsHotandhumidenvironmentCornealinjurybyplantCornealepitheliumabrasionContactlensCornealsurgerySystemicimmunedisorderlong-termantibioticsglucocorticoidimmunosuppressivedrugClinicalmanifestation

slowStimulatingsymptomlightTimelongCornealsignsgray,dry,dull,raised,immuneringpseudopod/satellitefociHypopyongray,viscous/pasty

“moss-like”、“toothpaste-like”white,raisedlesion

dryandgreyinfiltrate,plumoseborder

fungalkeratitisbyFusariumspp.DiagnosisCasehistorySigns

corneallesionLaboratoryexamination

cornealscrapingfungalculture(blood、chocolate、Sabouraud)

cornealbiopsyConfocalcornealmicroscope共焦角膜顯微鏡

10%KOHGiemsa

H.E.ConfocalmicroscopeTreatmentProhibition:GlucocorticoidAnti-fungusmedicinelocalamphotercinB0.25%二性霉素BNatamycin5%那他霉素

fluconazole2%氟康唑

systemicattentionofsideeffectMydriasis（散瞳）Operation:debridement(清創(chuàng)術(shù))conjunctivalflapcoverkeratoplasty

Herpessimplexkeratitis

HSKEtiologyHSKcornealinfectionbyHerpessimplexvirus(HSV)HSVDNAvirus,I,IItype

Iocular/lipsherpesIIgenitalherpespathogenesisHSVIvirus

primaryinfection(skinandmucosaonheadandface)

hideinsensoryneuron(trigeminalganglion)

fever,GCorimmunosuppressivedrugs

HSV

Ivirusactivation

transportingtocornealepitheliumbynerveinfectionrecurrenceClinicalmanifestation

Symptoms:

redeye、pain、tearing Photophobia、hypoesthesiaPrimaryinfection:

infant,fever,herpesonlip/head/face,anteriorauricularlymphnodesenlargement, eyesigns:conjunctivitis,keratitis

Recurrentinfection:

riskfactors:

Fever,trauma,stress,immunosuppressivedrugs,eposuretoultraviolet

classification

Epithelialkeratitis2/3HSK,dendritic,mapSuperficial,littledamagetovisionNutritionalkeratopathyCausedbybasalmembraneinjury,tearfilminstableornervenutritionaldisordersAnti-virusdrugsmakeworsesuperficialEndotheliitisDelayedhypersensitivereactiontovirusantigenbyendotheliumBedividedintodiscal,diffuseandlinearStromalkeratitisImmunestromalkeratitis:self-limiteddelayedhypersensitivereactiontovirusantigenNecrosticstromalkeratitis:Immuneinflammationmediatedbyantigen-antibody-complementVirusinfectionandimmuneinflammationDiagnosisCasehistorySigns

fociLaboratoryexamination

pathogenicexaminationelectronmicroscope:virusparticlesPCR

serumexaminationantibodyTreatmentMedicationAnti-virusdrugsACV,GCVImmuneantibodyinterferon,transferfactorsPromoteepithelialhealingEGFbFGFChinesemedcine調(diào)理氣血OperationcornealtransplantRecurrencepreventionpromotingresistanceAcanthamoebaKeratitis

棘阿米巴角膜炎

Etiology

infectionbyacanthamoeba

protozoon,2formstrophozoite(滋養(yǎng)體)

cystPathology

inflammation,abscessus(膿腫)Etiology

acanthamoebaexistwidelyinsoil,water,air,grainanddomesticanimalItscystcan’tbekilledeasilyRiskfactorsContactlensCornealforeignbodyWaterpollution:swimming、divingCornealoperationCornealdisease:dystrophia、bullouskeratopathy,

bacterialorviruskeratitisClinicalmanifestationSymptom

singleeye、red、severepain、

photophobia、tearingSigns

non-specialepitheliopathy（pseudo-arborization):infiltrate、ulcer、irregularepitheliumdefectpacket、cyst、speckle、buCornealStromairregularthickening、Radiatedneuritis、circularstromaininfiltrate

littlehypopyon、creaseofLaminaElasticaPosterior、KPDiagnosisMedicalhistoryandsignsTissuesmearandcultivationCornealbiopsyConfocalmicroscopeTreatment

drugcombination

氨基糖甙類，聚雙胍類或聯(lián)咪類NOGCLong-time>4m

cornealtransplantNon-infectivekeratitisInterstitialkeratitis

inflammatorycellinfiltrate,vascularizeCause:syphilis(梅毒),TB,HSVclinicalmanifestationStimulatingsymptoms:pain,photophobia,tearingSigns:sectorordiffuseinflammatoryinfiltrationVascularizeCornealopacity/edema/cicatrix

Treatmentanti-syphilis,anti-TB,

GC,Cycloplegics

interstitialkeratitisCornealStromaedema，lymphocytesinfiltrate,deepvascularizationImmunekeratitisPeripheralcorneaorcorneallimbusMoorenulcerprimary,chronic,painful,progressiveClinicalmanifestationSymptom:severepain,redness,photophobia,tearing,impairedvisionSigns:cornealulcer:

beginsintheperipheralcorneaandprogressescircumferentiallytothecentralcornea,Onlyincornea,nottoscleraNonormalcorneabetweenulcerandcorneallimbusTreatmentDrugs:Immunosuppressivedrugs,glucocorticoidOperation:cornealtransplant

Mooren’sulcerUlcerbeginfromperipherytocenterKeratomalacia

角膜軟化癥